Schema Therapy

Schema Therapy is a method to help people change negative (“maladaptive”) patterns which they have lived with for a long time, even when other methods and efforts they have tried before have been largely unsuccessful. Schemas are usually deeply ingrained and can be hard to change. Because of this difficulty, schema therapy is often used for difficult-to-treat mental health conditions such as personality disorders, childhood maltreatment, post-traumatic stress disordereating disorders and addictions/substance use disorders.
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Schema Therapy

WHAT IS SCHEMA THERAPY?

Schema Therapy is an integrative approach to treatment that combines aspects of cognitive-behavioural, experiential, interpersonal and psychoanalytic therapies into one unified model.

In psychology a ‘schema’ can be described as a mental structure of ideas and cognitions (a mental representations of how things are in the world) or a system of organising and perceiving information.

An ‘early maladaptive schema’ is a fairly stable trait or aspect of personality which develops in childhood through interactions with caregivers and other early experiences. Such experiences, interactions or patterns of attachment are negative and tend to be repetitive in nature. They can be obvious experiences of traumatic events or less obvious forms of trauma such as emotional abuse or neglect. Examples include experiences of abandonment at a young age, or verbal messages from a parent that made you feel unworthy or defective. In other words, these schemas developed when one or more of our core emotional childhood needs are not met or violated over time.

Schema-focused therapy aims to help patients move from maladaptive schemas to healthy, adult schemas. Changing schemas can help change life patterns and behaviours that have been driven by maladaptive schemas that can be problematic or related to mental illness.

To help people connect with others and meet their emotional needs, schema therapy aims to strengthen healthy schemas and unlearn or weaken maladaptive schemas.

HOW DOES SCHEMA THERAPY WORK?

Schema therapy treatment plans normally include assessment, education about schemas and work to change present schemas. Schema-focused therapy techniques include cognitive, behavioural and emotional components.

  • Cognitive Techniques – include evaluating present schemas and building rational evidence to challenge them. Clients may document this evidence against the schema in a schema diary, which they can carry around with them to reference during situations when they may need to challenge their beliefs.
  • Emotion-Focused Techniques – include imagery and dialogue, like role-play therapy or two chair work. These techniques allow the patient to play out situations that contributed to the schema development and confront their schemas head-on. Confronting schemas can empower the patient to break the emotional cycle of their current schema.
  • Therapeutic Relationship – The therapist and patient work closely together to address schemas and related beliefs and behaviours. The therapist demonstrates understanding and empathy of how these schemas developed, but also encourages the patient to change. This technique is known as empathic confrontation. The therapist also helps the patient analyse the schema and understand how their behaviours and thoughts contribute to it.
  • Behavioural Techniques – usually include confronting situations or feelings that are often avoided, usually through exposure therapy. During exposure therapy, patients visualise or discuss situations that are distressing to them and learn to cope with these situations more effectively. This method helps transition schema therapy to practice, which can be applied to the real world.

The schemas that are targeted in treatment are enduring and self-defeating patterns that typically begin early in life. These patterns consist of negative/dysfunctional thoughts and feelings, have been repeated and elaborated upon, and pose obstacles for accomplishing one’s goals and getting one’s needs met. Some examples of schema beliefs are: “I’m unlovable,” “I’m a failure,” “People don’t care about me,” “I’m not important,” “Something bad is going to happen,” “People will leave me,” “I will never get my needs met,” “I will never be good enough,” and so on.

Early Maladaptive Schemas

Early maladaptive schemas are developed as a result of early life challenges or environments. These maladaptive schemas can lead to mistrust and problematic thinking and often impact adult behaviour. There are 18 identified maladaptive schemas:

  1. Abandonment/Instability: Others will not be able to continue providing emotional support or connection. People with this schema believe that people will leave or abandon them for someone better.
  2. Mistrust/Abuse: Others will hurt, cheat, humiliate, lie to or take advantage of them. This level of mistrust is the result of the belief that others will intentionally or willingly hurt the individual.
  3. Emotional Deprivation: A person’s normal emotional needs will not be met by others. Schema therapy for emotional needs can help alter this belief.
  4. Defectiveness/Shame: One is bad, unwanted or defective. This schema involves intense feelings of shame and insecurity.
  5. Social Isolation/Alienation: The belief that a person is not a part of any group, community or doesn’t belong.
  6. Dependence/Incompetence: Often presenting as helplessness, this schema involves the belief that a person is unable to meet their own needs or take care of themselves without significant help from others.
  7. Vulnerability to Harm or Illness: The belief that danger or catastrophe can happen at any moment, and there is nothing a person can do to prevent it.
  8. Enmeshment/Undeveloped Self: This includes extreme emotional involvement with others in a person’s life, often their parents or a partner. This closeness comes at the cost of developing one’s own independent and fulfilling relationships.
  9. Failure to Achieve: The belief that one is a failure and will continue to fail. A person with this schema may believe that they are inadequate compared to those around them.
  10. Entitlement/Grandiosity: The belief that one is special, superior or has special powers that make them better than other people. People with this schema often believe that rules don’t apply to them and that they should get what they want. These individuals often lack empathy.
  11. Insufficient Self-Control/Self-Discipline: An inability or unwillingness to exert control over one’s behaviour or impulses. People with this schema tend to avoid discomfort and responsibility.
  12. Subjugation: Persistent surrender to others due to perceived coercion or avoidance of feelings of hurt or anger. This schema can include a person feeling the need to subjugate their own desires based on the belief that their beliefs or wants are not as important as other people’s.
  13. Self-Sacrifice: Extreme focus on putting other people’s needs ahead of one’s own, often to avoid feeling unneeded or guilty.
  14. Approval-Seeking/Recognition-Seeking: Driven by the need and desire to be noticed and recognised. This schema may include an overemphasis on the importance of status and achievement and may cause an individual to put recognition above their own needs or desires.
  15. Negativity/Pessimism: A persistent focus on the negative aspects of life, like disappointment, death and helplessness about the future. The potential positives in life are often ignored or overlooked.
  16. Emotional Inhibition: Suppressing spontaneous actions and feelings, often to avoid disappointing others or losing control of oneself.
  17. Unrelenting Standards / Hypercriticalness: A person must meet high internal and external standards that they set for themselves. Individuals with this schema are often unable to slow down or relax and may forgo pleasure and healthy relationships.
  18. Punitiveness: Others should be harshly punished for their beliefs. As a result, individuals with this schema can be intolerant, unforgiving and unwilling to consider external circumstances.

Coping Styles

In schema therapy, your reactions to schemas are known as coping styles. These can involve thoughts, feelings, or behaviours. They develop as a way of avoiding the painful and overwhelming emotions experienced as a result of a certain schema.

Coping styles can be helpful in childhood, as they provide a means of survival. But in adulthood, they can reinforce schemas.

There aren’t any firm rules about which schemas lead to certain coping styles. Your coping style might be based on your overall temperament or even coping styles you learned from your parents.

They also vary from person to person. Two people could respond to the same schema with the same style in very different ways. Similarly, two people with the same schema might also respond with two separate styles.

Your own coping style can also change over time, although you’re still dealing with the same schema.

The three main coping styles loosely correlate with the fight-or-flight or freeze response:

  • Surrender – This involves accepting a schema and giving into it. It usually results in behaviour that reinforces or continues the schema pattern. For example, if you surrender to a schema that formed as a result of emotional neglect as a child, you may later find yourself in a relationship involving emotional neglect.
  • Avoidance – This involves attempting to live without triggering the schema. You might avoid activities or situations that could possibly trigger it or make you feel vulnerable. Avoiding your schema may leave you more prone to substance use, risky or compulsive behaviour, and other behaviours that provide a distraction.
  • Overcompensation – This involves attempting to fight a schema by acting in complete opposition to it. This may seem like a healthy response to a schema, but overcompensation generally goes too far.

Schema Therapy Examples

Schema therapy can be used in many different situations. For example, within a failure to achieve schema, a person may believe that they are destined to fail or lose their job.

After receiving education on this schema and schema theory, a patient and therapist can discuss and document evidence that shows how a person is not failing at their job.

Evidence might include documenting praise from a boss, times deadlines were met or lack of interventions related to work performance.

The patient will then use this evidence to alter their thoughts, beliefs and behaviours surrounding this schema using various techniques. This process can be readily applied to other schemas, such as abandonment or unrelenting standards.

HOW LONG DOES SCHEMA THERAPY TAKE?

There is no standard guideline for how long schema therapy should take. Schemas are strongly held and deeply ingrained. Breaking down schemas can be a lengthy and difficult process.

Schema therapy can take months or years and is usually an ongoing process. Clients are required to evaluate their thought patterns and behaviour continually. Although this can be a lengthy and tedious process, schema therapy can improve an individual’s quality of life and chances of recovery.